Provider Demographics
NPI:1356062319
Name:WETZEL, JENNA MARIE (WHNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:WETZEL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 BREAN DOWN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4663
Mailing Address - Country:US
Mailing Address - Phone:330-301-6811
Mailing Address - Fax:
Practice Address - Street 1:2200 PARK BEND DR BLDG 2-201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5388
Practice Address - Country:US
Practice Address - Phone:512-339-4234
Practice Address - Fax:512-339-4237
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091159363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health